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Form SS-4 for Hollywood Florida: What You Should Know
Address:. City: State: AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY 5 Please include an itemized statement of all receipts, expenses, and costs in connection with the claim (for example, bills, bills of lading, or cost account sheets). Include the approximate dates and approximate dollar amounts of your expenses incurred as listed on the receipt or cost account sheets. Include the name and position of the person in charge of the office where your loss was caused and any other person(s) with authority to approve payments for or disburse the claim. 6 This statement must be provided at the conclusion of payment, if any. For information on how to prepare Statement of Claims, click here. Form SS-4-D (Settlement): 7 For additional information, click here. 8 This form is available from the Claims Department located in the Claims Area on the second floor of the City Hall, Suite 700, at 100 E. Fourth St. Los Angeles, CA 90012. Form SS-4-D : Tax Liability Claim Form — Form SS-4-D — City of Hollywood 9 In addition to the above, please also include: (1) An itemized list of all expenses incurred for repair or replacement of property damaged by your loss. Include all receipts, vouchers, or bills of lading to prove costs to replace the personal property lost, for example, loss of your computer and other property; (2) A description of your loss caused by a City employee. If you don't have any personal information, please provide information about the City employee at the time of the accident and their position; (3) A statement of the amount of the claimant's loss; (4) The name and position of any person in charge of the office in which damage was caused or the City in which the claim was filed before the injury occurred. 10 The City will reimburse the claimant in the amount the claimant elects to receive through a deductible escrow account. If you don't receive reimbursement, you must apply for reimbursement through the claimant's employer or other claimant's representative. If the claimant's employer does not require a claim, they may be eligible for a credit to the claim.
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